Sam Higginbottom University of Agriculture, Technology And Sciences

Directorate of Distance Education

APPLICATION FORM FOR THE ISSUE OF DUPLICATE CERTIFICATE / MARKSHEET

Read the Instruction carefully before filling the Form. All Fields of the Form are Mandatory.
Fee revised on 01-10-2021
Enrollment Number (As in the ID card) IPIP Code (Optional) Programme
–
Name of the Student as registered with the University at the time of admission

Father’s Name of the Student as registered with the University at the time of admission

Complete Address (Do not repeat the name)

District State

e-mail Address STD Code Phone / Mobile Number Pin code

Demand Draft No. Date Amount Name of the Bank

d d m m y y y y Rs.
(The Demand Draft in favour of “DDE, SHUATS” a/c payable at Allahabad)
Academic Details
Sl. Programme & Semester/Year Month & Year of passing IPIP Code Total Marks obtained in the Semester/Year
1
2
3
4
5
6
7
8
Note : Attach self-attested copies of Mark-Sheets of all Semesters/Years.
Nature of Certificate required
(1) Statement of Marks / Grade Sheet -- Rs. 1000/- each
(2) Provisional or Migration Certificate -- Rs. 750/- up to Convocation.
(No Provisional Certificate will be issued after the Convocation.)
(3) Consolidated Statement of Marks /Grades -- Rs. 1000/-
(4) Degree Certificate -- Rs. 2000/-
IMPORTANT INSTRUCTIONS
Duplicate certificate will be issued only when it is lost or destroyed irrevocably.
• The following procedure is to be adopted by the student for getting a duplicate certificate be issued from the SHUATS University.
• Publication in the newspaper about the loss of the certificate. The date should be visible.
• Provide an affidavit prepared by a Notary on a non-judicial stamp paper of Rs 10/-. (The matter to be printed on
the affidavit is attached).
• Write an application addressed to “The Director, Distance Education, SHUATS University” mentioning the loss of
your certificate and reference of above documents.
• Attach a Xerox copy of the original certificates provided to you by SHUATS University (if available).
• While publishing such notification in the newspaper, the name of the student with initial, Registration No., Name of the
University in which certificate was obtained etc. to be provided without fail.
• Application should be completed in every respect. Failure to furnish correct details may cause delay in the issue of the
certificate.
• The fee should be paid in the form of Demand Draft drawn in favour of the “DDE, SHUATS” payable branch at Allahabad
from any bank. Fee once paid will not be refunded or adjusted for any other certificate under any circumstances.
The complete Form along with all the required enclosures must be sent on the following address:
DIRECTOR
Directorate of Distance Education
Sam Higginbottom University of Agriculture, Technology And Sciences
Naini, Allahabad-211 007
Phone : 0532-2684317
• May kindly note that it takes approximately 30 working days from the day of receiving the above documents to process an application
for the issuance of a duplicate certificate (this excludes postal time).
 Sam Higginbottom University of Agriculture, Technology And Sciences
Directorate of Distance Education

APPLICATION FORM FOR THE ISSUE OF DUPLICATE CERTIFICATE / MARKSHEET

Format of the Affidavit (On Rs. 10/- Judicial Stamp Paper)
Following Affidavit is to be enclosed with the Application Form

I, son / daughter of
Aged residing at solemnly affirm and
state as follows:

1. I declare that I have lost the original testimonial as detailed below :

Enrollment No. Particulars of the Original Testimonial Lost

2. I declare that in spite of diligent search I am unable to trace the originals of the aforesaid document and hence
they are lost. If traced, I will produce them before the University.

3. I declare that I have not misused the same and I shall not misuse the same if recovered.

4. I declare that for the purpose of I need the certified

duplicates of the aforesaid document.

5. It is therefore necessary that on the strength of this affidavit certified duplicates are issued to me by the
university.

6. The facts stated are true and correct to the best of my knowledge and if found false by the University,
I shall abide by the decision of the University.

Signature of the DEPONENT

Solemnly affirmed and signed before me on this day of

Dt

NOTARY PUBLIC